Changing patterns in long-term noninvasive ventilation: a 7-year prospective study in the Geneva Lake area

Chest. 2003 Jan;123(1):67-79. doi: 10.1378/chest.123.1.67.


Study objectives: To describe a 7-year follow-up (1992 to 2000) of patients who were treated by home nasal positive-pressure ventilation (NPPV) for chronic hypercapnic respiratory failure.

Design: Prospective descriptive study.

Setting: Two university hospitals and a pulmonary rehabilitation center.

Patients: Two hundred eleven patients with obstructive pulmonary disorders (58 patients) or restrictive pulmonary disorders (post-tuberculosis, 23 patients; neuromuscular diseases [NM], 28 patients; post-poliomyelitis syndrome, 12 patients; kyphoscoliosis [KYPH], 19 patients; obesity-hypoventilation syndrome [OHS], 71 patients) who were treated by long-term NPPV.

Intervention: Annual, elective, standardized medical evaluations.

Measurements: Pulmonary function tests, arterial blood gas levels, health status, compliance, survival and probability of pursuing NPPV, and hospitalization rates.

Results: Patients with OHS, NM, and KYPH had the highest probability of pursuing NPPV, while patients with COPD had the lowest values. Overall, the compliance rate was high (noncompliance rate, 15%). As of 1994, COPD and OHS became the most frequent indications for NPPV, increasing regularly, while other indications remained stable. The use of pressure-cycled ventilators progressively replaced that of volume-cycled ventilators in most indications. Hospitalization rates decreased in all groups after initiating NPPV, when compared with the year before NPPV, for up to 2 years in COPD patients, and 5 years in non-COPD patients.

Conclusion: Major changes in patient selection for NPPV occurred during the study period with a marked increase in COPD and OHS. The shift toward less expensive pressure-cycled ventilators and the decrease in hospitalizations after initiating NPPV have had positive impacts on the cost-effectiveness of NPPV in patients with chronic respiratory failure.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Equipment Design
  • Health Status Indicators
  • Humans
  • Middle Aged
  • Patient Compliance
  • Prospective Studies
  • Respiration, Artificial* / instrumentation
  • Respiration, Artificial* / methods
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy*
  • Switzerland
  • Time Factors
  • Treatment Refusal